Effect of glucose tablets on craving for cigarettes

Sweet-liking and sugar supplementation as innovative components in substance use disorder treatment: A systematic review

OBJECTIVE

Substance use disorders are a major global public health concern. While a wide range of psychotherapies and pharmacotherapies are available for their treatment, efficacy is limited and many patients fail to benefit from these treatments. Like addictive substances, sugar seems to trigger the dopaminergic reward centre, and sweet-liking might be a modifier of substance use disorder treatment.

METHOD

Systematic review to summarize the role of sugar and sugar-liking in addiction and addiction treatment.

RESULTS

Evidence from both preclinical and clinical studies suggests that a certain portion of the population has a genetic predisposition for sweet-liking, which might be related to a higher risk for substance use and dependence. Regarding nicotine dependence, glucose supplementation prior to or during smoking cessation rapidly mitigates withdrawal symptoms and increases smoking abstinence rates during nicotine replacement therapy. In alcohol dependence, sweet-liking patients encounter more challenges in achieving abstinence than sweet-disliking patients. In addition, sweet-liking patients with high cravings demonstrate higher abstinence rates than sweet-disliking patients. Finally, sweet-liking is associated with successful outcomes of naltrexone treatment in patients with an alcohol use disorder.

CONCLUSION

These findings present promising new challenges and opportunities to fine-tune and optimize treatment protocols in addiction care.

Complementing the Standard Multicomponent Treatment for Smokers With Denicotinized Cigarettes: A Randomized Trial

INTRODUCTION

Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral support but do not address the sensory and behavioral aspects of smoking which may play a role in maintaining smoking behavior. Replacing such sensations temporarily after cessation may enhance treatment efficacy. We hypothesized that denicotinized cigarettes (DNCs), which have a very low nicotine content but provide these sensory and behavioral stimuli, could help alleviate urges to smoke and tobacco withdrawal symptoms and in turn enhance the efficacy of ST.

METHODS

Two hundred smokers seeking treatment received nine weekly behavioral support sessions and pharmacotherapy (100 used varenicline, 100 used nicotine replacement therapy). They were randomized on the target quit day to receive 280 DNCs (used ad libitum over 2 weeks in addition to ST) or ST alone.

RESULTS

Urge-to-smoke frequency (2.61 vs. 2.96, P = .03) but not strength (2.85 vs. 3.10, P = .20) in the first week of abstinence was significantly lower in DNC users versus ST alone. There were no differences in composite withdrawal scores between groups. Abstinence was significantly higher among DNC users versus ST alone at 1 (OR = 2.07; 95% CI: 1.63% to 3.70%) and 4 weeks (OR = 1.83; 95% CI: 1.05% to 3.21%), but not at 12 weeks (OR = 1.42; 95% CI: 0.79% to 2.55%). DNC use was a significant predictor of abstinence at 1 and 4 weeks (OR = 2.63; 95% CI: 1.40% to 4.93% and OR = 2.38; 95% CI: 1.26% to 4.46%), but not at 12 weeks.

CONCLUSIONS

Adding DNCs to ST has the potential to assist smokers early in their quit attempt, but research is needed to determine how best to utilize DNCs in treatment.

The acute effects of yogic breathing exercises on craving and withdrawal symptoms in abstaining smokers

RATIONALE

Breathing exercises have been proposed as a way of combating cigarette cravings, potentially presenting a low-cost, easily scalable smoking cessation aid.

OBJECTIVE

The aim of this study is to evaluate the acute impact of breathing exercises based on yogic pranayama on cravings in abstaining smokers.

METHODS

Participants visited the laboratory on two occasions 24 h apart and were asked to abstain from smoking 12 h prior to the first visit until the end of the second visit. Smokers (N = 96) were randomly allocated to a yogic breathing exercise (YBG) or video control (VCG) group. The former was instructed on breathing exercises, practised these for 10 min and asked to use these when experiencing cravings until the next visit. The latter was shown a breathing exercise video for 10 min and asked to concentrate on their breathing. Strength of urges to smoke, other craving measures and mood and physical symptoms associated with cigarette withdrawal were assessed at the beginning and end of the first visit, and again at the second visit.

RESULTS

At immediate follow-up, in the laboratory, all craving measures were reduced in YBG compared with VCG (strength of urges: F(1, 96) = 16.1, p < 0.001; cigarette craving: F(1, 96) = 11.3, p = 0.001; desire to smoke: F(1, 96) = 6.6, p = 0.012). There was no effect on mood or physical symptoms. Adherence to the breathing exercise regimen in the following 24 h was low, and at 24 h follow-up, there was no evidence of reduced cravings in YBG compared with VCG.

CONCLUSIONS

Simple yogic-style breathing exercises can reduce cigarette craving acutely in the laboratory. Further research is needed to determine how far this translates into field settings.

The effect of chewing gum flavor on the negative affect associated with tobacco abstinence among dependent cigarette smokers

Many smokers relapse during cessation attempts due to increases in negative affect. Previous research has shown that chewing confectionary chewing gum appears to lessen the severity of acute nicotine withdrawal symptoms and help individuals who are trying to reduce smoking in part due to the flavor of the gum chewed. The current study compared the effects of three flavored gums to a No Gum Control during 48-hour cessation periods for young dependent smokers. Forty-nine smokers participated in three experimental conditions (peppermint, vanilla, and baked apple cardamom flavored gum) as well as a No Gum Control across four weeks while abstaining from smoking for 48-hours each week. Compared to the No Gum Control, participants in the Gum conditions reported lower levels of anxiety, dysphoria, and tension. Vanilla and baked apple cardamom flavored gum resulted in lower levels of negative affect while peppermint flavored gum was not different from the No Gum Control. These findings indicate that some flavors of gum are effective in reducing the negative affect associated with nicotine withdrawal and may serve as a valuable tool in helping smokers quit.

Low-dose naltrexone augmentation of nicotine replacement for smoking cessation with reduced weight gain: a randomized trial

BACKGROUND

Fear of weight gain is a significant obstacle to smoking cessation, preventing some smokers from attempting to quit. Several previous studies of naltrexone yielded promising results for minimization of post-quit weight gain. Given these encouraging findings, we endeavored to test whether minimization of weight gain might translate to better quit outcomes for a population that is particularly concerned about gaining weight upon quitting.

METHODS

Smokers (N=172) in this investigation were prospectively randomized to receive either 25 mg naltrexone or placebo for 27 weeks (1 week pre-, 26 weeks post-quit) for minimization of post-quit weight gain and smoking cessation. All participants received open label therapy with the nicotine patch for the first 8 weeks post-quit and behavioral counseling over the 27-week treatment. The 2 pre-specified primary outcomes were change in weight for continuously abstinent participants and biologically verified end-of-treatment 7-day point-prevalence abstinence at 26 weeks after the quit date.

RESULTS

The difference in weight at 26 weeks post-quit between the naltrexone and placebo groups (naltrexone: 6.8 lbs ± 8.94 vs placebo: 9.7 lbs ± 9.19, p = 0.45) was not statistically different. Seven-day point-prevalence smoking abstinence rates at 26 weeks post-quit was not significantly different between the 2 groups (naltrexone: 22% vs placebo: 27%, p = 0.43).

CONCLUSIONS

For smokers high in weight concern, the relatively small reduction in weight gain with low-dose naltrexone is not worth the potential for somewhat lower rates of smoking abstinence.

Impulsivity as a behavioral measure of withdrawal of orally delivered PCP and nondrug rewards in male and female monkeys

BACKGROUND

Withdrawal of phencyclidine (PCP), ethanol (ETOH), and other drugs reduces operant responding maintained by food.

OBJECTIVES

Experiment 1 examined the effects of withdrawing daily short access (2 h) to drug on impulsivity for saccharin (SACC) using a delay discounting task and comparing male and female rhesus monkeys. Experiment 2 examined the effects of withdrawing a nondrug substance (e.g., food or SACC) on impulsivity for PCP.

MATERIALS AND METHODS

In experiment 1, either PCP or ETOH was available daily with water for 2 h under a fixed ratio 16 (FR 16) or FR 8 schedule, respectively. In a second component, SACC was available for 45 min under a delay discounting schedule. Next, water was substituted, and drug access was then restored. In experiment 2, PCP was available under a delay discounting schedule during food satiation or restriction or during concurrent SACC vs water access.

RESULTS

In experiment 1, withdrawal of 0.5 mg/ml PCP increased impulsivity for SACC, but not SACC intake, in males and females. During 16% ETOH access, impulsivity for SACC was elevated compared to baseline water access, and it returned to baseline levels during ETOH withdrawal. In experiment 2, food restriction resulted in increased PCP intake in males and females and increases in impulsivity for PCP that were greater in males than in females. SACC withdrawal had no effect on impulsivity for PCP or PCP intake.

CONCLUSIONS

Withdrawal of PCP and reduced food access increased impulsivity for SACC or PCP, respectively. Impulsivity is a sensitive indicator of drug dependence.

Effects of cigarette smoking and family history of alcoholism on sweet taste perception and food cravings in women

BACKGROUND

Despite popular beliefs that smoking affects the sensitivity and liking of sweet-tasting foods and beverages, few psychophysical studies have examined this phenomenon and none have taken into account the individual's family history of alcoholism (FH+), a predictor of heightened sweet preferences.

METHODS

A within- and between-subjects study was conducted to determine the effect of both cigarette smoking and an acute exposure to nicotine on sweet taste sensitivity and preferences in women. Two groups were studied on 2 days separated by 1 week: women who were current smokers (n = 27, 18 were FH+) and those who never smoked in their lifetime (n = 22, 9 were FH+). Current smokers smoked nicotine-containing cigarettes during 1 test session and nicotine-free cigarettes during the other. The procedures were identical during both test sessions for the group of never smokers, with the exception that they did not smoke. Two-alternative staircase methods and forced-choice tracking procedures were used to assess sucrose thresholds and preferences, respectively, during both test session. Standardized questionnaires were administered to assess food cravings as well as smoking and alcohol usage and dependence. The Family Interview for Genetic Studies was used to detect alcoholism according to the DSM III criteria for family members up to second-degree relatives.

RESULTS

Acute exposure to nicotine did not affect sucrose detection thresholds or preferences, but smokers had significantly higher sucrose detection thresholds than never smokers. The greater the smoking dose in pack-years, the lower the sucrose sensitivity. Regardless of smoking status, women who were FH+ preferred significantly higher sucrose concentrations and craved sweets more often than women who were not.

CONCLUSIONS

Both smoking and having a family history of alcoholism had differential effects on sweet taste. Smoking was associated with decreased sweet taste sensitivity whereas having a family history of alcoholism was associated with heightened sweet preferences. These findings suggests that future research on the effects of smoking on food habits and cravings should take into account family history of alcoholism given its association with sweet liking and the increased likelihood to develop a tobacco disorder.

Effects of rapid smoking on post-cessation urges to smoke

CONTEXT

Rapid smoking (RS) is a smoking cessation technique with sufficient indications of promise to warrant further investigation. The main presumed effect of RS is on reducing desire to smoke.

AIM

To evaluate the effect of a single session of RS immediately prior to quitting smoking on urges to smoke over the first week of abstinence.

DESIGN

Randomized controlled trial.

SETTING

Specialist smoking cessation clinic (SSCC).

PARTICIPANTS

A total of 100 smokers attending the quit day session.

INTERVENTION

Participants in the rapid smoking group underwent a single session of RS immediately prior to quitting smoking. Participants in the control group watched a health promotion video on giving up smoking.

PRIMARY OUTCOME MEASURES

Ratings of urges to smoke in the first 24 hours and 1 week of abstinence.

FINDINGS

The RS procedure was well tolerated. It led to significantly lower urges to smoke compared to the control procedure during the first 24 hours (mean rating of 2.6 versus 3.2, P < 0.001) and the first week of abstinence (1.8 versus 2.5, P < 0.01). In patients abstinent for 4 weeks, urges to smoke were low and the difference was no longer significant (1.4 versus 1.8).

CONCLUSION

RS has an 'active ingredient' (craving reduction) and its effects on smoking cessation may merit further examination using modern rigorous methodology.

Effect of nicotine replacement therapy on post-cessation weight gain and nutrient intake: a randomized controlled trial of postmenopausal female smokers

This study of 94 postmenopausal female smokers evaluated the effect of nicotine replacement therapy (NRT) and hormone therapy (HT) on change in weight, energy intake, and physical activity during 2 weeks of smoking abstinence. Women, stratified by current use of HT, were randomized to nicotine or placebo patch. After 2 weeks of abstinence, women on nicotine patch had significantly larger increases in total caloric and fat intake than women on placebo patch and a trend toward larger increases in carbohydrates (total and sweet). Conversely, the nicotine group had less weight gain, 0.47 kg, than the placebo group, 1.02 kg (F=10.31, p=0.002). No effects were observed for hormone therapy. It appears that in short-term smoking abstinence, postmenopausal women on NRT gain less weight than do women on placebo, in spite of consuming more calories. This may be beneficial in the critical first 1-2 weeks of tobacco cessation, especially in light of postmenopausal weight gain.

Effect of glucose on tobacco craving. Is it mediated by tryptophan and serotonin?

RATIONALE

Oral glucose has been shown to decrease tobacco craving in many but not all previous studies. Glucose ingestion may facilitates entry of tryptophan (TRP), the unique source of brain serotonin, into the brain, glucose's action seems to be opposite of rapid TRP depletion. Therefore, the aim was to assess the effect of high doses of oral glucose on tobacco craving, withdrawal symptoms, plasma TRP and blood serotonin concentrations in temporarily abstinent smokers.

METHODS

Aspartame 0.6 g/200 ml (A, placebo), glucose 32.5 g/200 ml (G32.5) and 75 g/200 ml water (G75) were administered to 12 healthy smokers after an overnight abstinence in a crossover, double blind study. Tobacco craving (short version of the Tobacco Craving Questionnaire, TCQ), withdrawal symptoms, choice reaction time, affect, blood glucose, plasma insulin, nicotine, cotinine, free and total TRP, and blood serotonin concentrations were assessed during a period of 5 h after administration.

RESULTS

Blood glucose and plasma insulin increased after G32.5, G75 and remained unchanged after A. TCQ score increased with A and remained almost unchanged with both doses of glucose (conditionxtime interaction: P=0.023). Total withdrawal score increased differently according to sex and condition (P<0.05). Motor reaction time increased with A and decreased with glucose (P=0.016). The overall decrease in plasma TRP was 0.31+/-17, 0.49+/-0.19 and 1.44+/-0.24 mg/l with A, G32.5 and G75, respectively (P<0.001). Baseline blood serotonin was lower in women (n=5) than in men; it showed a condition by time (P=0.007) and a condition by time by sex interaction (P=0.023).

CONCLUSIONS

Glucose attenuates tobacco craving and withdrawal symptoms in temporarily abstinent smokers. This is accompanied by a decrease in plasma TRP and a sex dependent increase in blood serotonin. Further studies assessing the direct effect of glucose on brain serotonin are needed to ascertain whether a glucose induced reduction in craving is associated with an increase in brain serotonin.

Chronic access to a sucrose solution enhances the development of conditioned place preferences for fentanyl and amphetamine in male Long-Evans rats

Consumption of palatable food and fluids alters the behavioral consequences of psychoactive drugs. To further investigate the effects of intake of palatable nutrients on the rewarding properties of these drugs, the effects of chronic intake of a sweet sucrose solution on the development of conditioned place preferences (CPP) to a mu-opioid agonist, fentanyl, and to a stimulant drug, amphetamine, were examined. Male Long-Evans rats consumed laboratory chow and water or chow, water, and a 32% sucrose solution. CPP testing was conducted in a three-chamber apparatus. In Experiment 1 (over four conditioning days), rats received saline, 0.004, or 0.016 mg/kg sc fentanyl citrate before being placed on the nonpreferred side of the apparatus and saline (subcutaneously) before being placed on the preferred side during a separate session on the same day. When given access to all three chambers, rats injected with 0.016 mg/kg fentanyl spent significantly more time on the drug-paired side than rats injected with saline. Furthermore, sucrose-fed rats displayed a significantly greater CPP than chow-fed rats. After conditioning, rats were tested for fentanyl-induced antinociception using the tail-flick test. Using a cumulative dose procedure, fentanyl (0.003, 0.010, 0.030, and 0.100 mg/kg sc) led to dose-dependent increases in tail-flick latencies. Rats fed with sucrose displayed significantly greater responses to fentanyl than those in the chow group. In Experiment 2, rats spent significantly more time on the drug-paired side of the CPP apparatus following injections of 0.33 or 1.0 mg/kg amphetamine than after saline injections. Additionally, following injection of 0.33 mg/kg amphetamine, sucrose-fed rats spent significantly more time on the drug-paired side of the chamber than chow-fed rats.

Glucose for smoking cessation: does it have a role?

Nicotine replacement therapies and amfebutamone (bupropion) have both been shown to aid smoking cessation. However, even with the best support most attempts to stop smoking fail, and many smokers prefer not to use medications in their quit attempts. Oral dextrose (glucose) has been proposed as a possible aid to smoking cessation which would be very inexpensive and might be used by some smokers as well as or instead of medications. It is hypothesised that single doses of nicotine relieve hunger in smokers so that over time smokers therefore come, in certain situations, to interpret sensations associated with hunger as craving for a cigarette. Adaptation to long term nicotine intake leads to exacerbation of these sensations during periods of abstinence. Chewing dextrose tablets results in a rapid increase in blood glucose levels that would be expected to yield a small reduction in these sensations which might then translate into a reduction in craving. An intervention that reduced craving might help smokers to maintain abstinence. Placebo-controlled studies have provided some support for the hypothesis that chewing glucose tablets can reduce desire to smoke during abstinence, and the one adequately powered study carried out so far found that glucose tablets increased 1-month abstinence rates significantly compared with a placebo. Definitive trials are now required but, given their low cost, glucose tablets may be a useful aid for some smokers.

Chronic sucrose intake enhances nicotine-induced antinociception in female but not male Long-Evans rats

Previous work has demonstrated that intake of palatable foods can alter the behavioral actions of opioid drugs. To investigate whether intake of palatable fare only affects opioid-induced behaviors or more generally influences drug-induced responses, this study examined the effects of chronic intake of a palatable sucrose solution on nicotine-induced antinociception. Eight male and eight female Long-Evans rats were provided with ground chow and water (control group), while eight males and eight females were provided with chow, water and a 32% sucrose solution (sucrose group). After 3 weeks of exposure to the dietary conditions, all rats were tested for nicotine-induced antinociception using the tail flick test. Nicotine, administered using a cumulative dose regime (0.03, 0.1, 0.3 and 1.0 mg/kg sc), led to dose-dependent increases in tail flick latencies in male and female rats. Females in the sucrose group displayed significantly greater antinociceptive responses to nicotine than those in the control group. Similar results were obtained when females were retested after an additional 2 weeks. Comparison of males and females, revealed that sucrose enhanced nicotine's antinociceptive action in female but not in male rats. While previous research suggested that sweet tasting substances might affect drug action by acting on the endogenous opioid system, the present results indicate that sucrose intake could also alter the cholinergic system and possibly other systems involved in nicotine antinociception.

Advances in non-nicotine pharmacotherapy for smoking cessation

Progress in understanding the pharmacological nature of tobacco addiction, along with the modest success rates achieved by the nicotine replacement therapies, has provided the major impetus for the development of non-nicotine drugs as smoking cessation aids. This article reviews evidence from controlled trials of several non-nicotine medications for the treatment of nicotine dependence. Clonidine was the first non-nicotine medication to show efficacy for smoking cessation in multiple studies, but its effect was found to be limited at best. Positive results across several trials have been consistently demonstrated for amfebutamone (bupropion). Encouraging results have also been observed for nortriptyline and moclobemide. Studies of combined treatments using non-nicotine medications (amfebutamone, mecamylamine, oral dextrose) with nicotine replacement therapy suggest increased efficacy relative to treatments using one or the other treatment strategy alone. Thus, available evidence indicates that non-nicotine drug treatments offer a promising panoply of therapeutic strategies for the addicted smoker.

The effect of ephedrine plus caffeine on smoking cessation and postcessation weight gain

OBJECTIVES

To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation.

METHODS

This randomized double-blind placebo-controlled study with a 1-year follow-up period was carried out at the Department of Pulmonary Medicine in Denmark. Study subjects were 225 heavy smokers who wanted to quit smoking without gaining weight. Two-thirds of the subjects were randomized to receive 20 mg ephedrine plus 200 mg caffeine three times a day; one-third of the subjects received placebo treatment. The dosage was gradually decreased from week 12 to discontinuation at week 39. Group support and control were performed at entry and after 1, 3, 6, 12, 26, 39, and 52 weeks. Main outcome measures were (1) self-reported abstinence with validation by carbon monoxide in expired air and serum cotinine and (2) weight gain.

RESULTS

The success rates after 1 year were 17% in the group treated with ephedrine plus caffeine and 16% in the group treated with placebo; the success rates were not significantly different at any time. The success rates for the four counseling physicians varied between 7% and 27% after 1 year (p < 0.05). The weight gain was significantly lower in the ephedrine plus caffeine-treated group during the first 12 weeks, but weight gains were similar after 1 year. No differences in the smoking withdrawal symptoms could be observed between the treatment groups. HbA1c was lower 6 weeks and 1 year after smoking cessation (p < 0.05).

CONCLUSIONS

We found an effect of this combination of ephedrine and caffeine on weight gain during the first 12 weeks, but we found no effect on the success rates or craving for cigarettes.

Effects of tobacco smoking on caloric intake

Reduced body weight due to smoking may be an important factor inhibiting smoking cessation and promoting relapse after cessation in some smokers. It is popularly believed that smoking decreases body weight by suppressing appetite. However, cross-sectional studies show that, despite their lower body weights, smokers do not eat less than non-smokers or ex-smokers and, in fact, tend to eat slightly more. Similarly, laboratory studies show no acute effects of smoking or nicotine intake via other means on caloric intake in smokers, although intake of non-smokers may be reduced after nicotine. In contrast, longitudinal studies show that eating consistently increases in the first weeks after stopping smoking, but may recede to pre-cessation levels with longer-term abstinence, while resumption of smoking after cessation is accompanied by a reduction in eating. A similar pattern of results is seen for self-reported hunger and some, but not all, constituents of diet. Thus, there appear to be no acute or chronic effects of smoking on eating in smokers maintaining regular smoking, but changes in eating are observed concomitant with changes in smoking status (i.e. cessation or relapse). Although tolerance to anorectic effects of nicotine is one potential explanation, these findings may be more parsimoniously explained by viewing changes in eating due to smoking as secondary to an alteration in the set point around which body weight is regulated. According to this notion, cessation is accompanied by increased eating only until a new, higher body weight set point is reached, while relapse (and perhaps initiation of smoking) decreases eating only until a lower set point is reached. Implications of these findings and a set point explanation for them are discussed.

The role of nicotine in tobacco use

The 1988 US Surgeon General's Report titled "Nicotine Addiction", is cited frequently in the literature as having established the "fact" that nicotine derived from cigarette smoke is addictive in the same sense as "classic" addicting drugs such as heroin and cocaine. This manuscripts critically evaluates key research findings used in support of this claim and identifies shortcomings in the data that seriously question the logic of labeling nicotine as "addictive". In addition, the manuscript argues that the role of nicotine in tobacco use is not like the role of cocaine in coca leaf use as argued by the 1988 Surgeon General's Report, but is, in fact, more like the role of caffeine in coffee drinking as concluded in the 1964 US Surgeon General's Report.

Towards better diagnoses and more individual treatment of tobacco dependence

The nicotine dependence concept is well founded and it is clear that it is necessary to assess this before treatment starts. Behavioural dependence, although difficult to disentangle from the pharmacological dependence, is also important. With the development of tools for assessing behavioural dependence, the behavioural treatment methods could be applied to patients more appropriately. The place of new drugs such as clonidine and antidepressants is also discussed. It is suggested that some of the nicotine withdrawal syndrome may have similarities with hypoglycemia and increased eating after stopping smoking may be a form of self-medication. Lastly, the new forms of giving nicotine replacement are put in perspective.